Healthcare Provider Details

I. General information

NPI: 1669086898
Provider Name (Legal Business Name): SHELLY LOWRY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19680 MCCORD RD
ELKINS AR
72727-8932
US

IV. Provider business mailing address

19680 MCCORD RD
ELKINS AR
72727-8932
US

V. Phone/Fax

Practice location:
  • Phone: 479-466-9097
  • Fax:
Mailing address:
  • Phone: 479-466-9097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number121858
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: